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Questions have been raised regarding differences in the standards of care that patients receive when they are admitted to or discharged from in-patient units at weekends.
To compare the quality of care received by patients with anxiety and depressive disorders who were admitted to or discharged from psychiatric hospital at weekends with those admitted or discharged during the ‘working week’.
Retrospective case-note review of 3795 admissions to in-patient psychiatric wards in England. Quality of care received by people with depressive or anxiety disorders was compared using multivariable regression analyses.
In total, 795 (20.9%) patients were admitted at weekends and 157 (4.8%) were discharged at weekends. There were minimal differences in quality of care between those admitted at weekends and those admitted during the week. Patients discharged at weekends were less likely to be given sufficient notification (48 h) in advance of being discharged (OR = 0.55, 95% CI 0.39–0.78), to have a crisis plan in place (OR = 0.65, 95% CI 0.46–0.92) or to be given medication to take home (OR = 0.45, 95% CI 0.30–0.66). They were also less likely to have been assessed using a validated outcome measure (OR = 0.70, 95% CI 0.50–0.97).
There is no evidence of a ‘weekend effect’ for patients admitted to psychiatric hospital at weekends, but the quality of care offered to those who were discharged at weekends was relatively poor, highlighting the need for improvement in this area.
Gun violence is a large and growing problem in the United States. Many reformers look towards elections to spur policy change in this area. In this paper, we explore the effects of school shootings on electoral mobilization and election outcomes. We pair data from several sources that measure validated voter registration; validated voter turnout; and the electoral performance of officials at the local, state, and federal levels with regression discontinuity and panel methods. Our effects show that shootings have little to no effect on electoral outcomes in the United States. Our work demonstrates that even when tragic events occur that are squarely in the realm of elected officials’ responsibility, have high levels of issue salience, are highly-covered by the media, draw citizens’ attention, and (perhaps) shift public opinion, these seemingly favorable conditions may not be enough to elicit democratic accountability.
Nested data arise frequently in clinical research. The nesting might be hierarchical, such as patients nested within clinicians, or it might be longitudinal, such as repeated assessments over time nested within individuals. As articulated in this chapter, whenever and however nesting occurs, it is necessary to account for the statistical dependence of observations within units when analyzing the data. Further, it is important to determine the level(s) of the data at which predictors exert their effects. Multilevel models are a particularly popular and useful approach for addressing these issues. We thus describe these models in detail, illustrating the application of multilevel models in clinical research via two examples. The first example considers nesting of siblings within families and demonstrates the importance of separating within- versus between-family effects. The second example focuses on the application of multilevel models with repeated measures to evaluate within-person change over time. Additionally, we provide a brief survey of other approaches to the analysis of nested data (e.g., cluster-robust standard errors, generalized estimating equations, fixed-effects models).
Research on psychotic illness is loosening emphasis on diagnostic stringency in favour of including a more dimensionally based conceptualization of psychopathology and pathobiology. However, to clarify these notions requires investigation of the full scope of psychotic diagnoses.
The Cavan–Monaghan First Episode Psychosis Study ascertained cases of first episode psychosis across all 12 DSM-IV psychotic diagnoses via all routes to care: public, private or forensic; home-based, outpatient or inpatient. There was no arbitrary upper age cut-off and minimal impact of factors associated with variations in social milieu, ethnicity or urbanicity. Cases were evaluated epidemiologically and assessed for psychopathology, neuropsychology, neurology, antecedent factors, insight and quality of life.
Among 432 cases, the annual incidence of any DSM-IV psychotic diagnosis was 34.1/100 000 of population and encompassed functional psychotic diagnoses, substance-induced psychopathology and psychopathology due to general medical conditions, through to psychotic illness that defied contemporary diagnostic algorithms. These 12 DSM-IV diagnostic categories, including psychotic disorder not otherwise specified, showed clinical profiles that were consistently more similar than distinct.
There are considerable similarities and overlaps across a broad range of diagnostic categories in the absence of robust discontinuities between them. Thus, psychotic illness may be of such continuity that it cannot be fully captured by operational diagnostic algorithms that, at least in part, assume discontinuities. This may reflect the impact of diverse factors each of which acts on one or more overlapping components of a common, dysfunctional neuronal network implicated in the pathobiology of psychotic illness.
Dissemination and implementation (D&I) science is not a formal element of the Clinical Translational Science Award (CTSA) Program, and D&I science activities across the CTSA Consortium are largely unknown.
The CTSA Dissemination, Implementation, and Knowledge Translation Working Group surveyed CTSA leaders to explore D&I science-related activities, barriers, and needed supports, then conducted univariate and qualitative analyses of the data.
Out of 67 CTSA leaders, 55.2% responded. CTSAs reported directly funding D&I programs (54.1%), training (51.4%), and projects (59.5%). Indirect support (e.g., promoted by CTSA without direct funding) for D&I activities was higher – programs (70.3%), training (64.9%), and projects (54.1%). Top barriers included funding (39.4%), limited D&I science faculty (30.3%), and lack of D&I science understanding (27.3%). Respondents (63.4%) noted the importance of D&I training and recommended coordination of D&I activities across CTSAs hubs (33.3%).
These findings should guide CTSA leadership in efforts to raise awareness and advance the role of D&I science in improving population health.
The efficient and effective movement of research into practice is acknowledged as crucial to improving population health and assuring return on investment in healthcare research. The National Center for Advancing Translational Science which sponsors Clinical and Translational Science Awards (CTSA) recognizes that dissemination and implementation (D&I) sciences have matured over the last 15 years and are central to its goals to shift academic health institutions to better align with this reality. In 2016, the CTSA Collaboration and Engagement Domain Task Force chartered a D&I Science Workgroup to explore the role of D&I sciences across the translational research spectrum. This special communication discusses the conceptual distinctions and purposes of dissemination, implementation, and translational sciences. We propose an integrated framework and provide real-world examples for articulating the role of D&I sciences within and across all of the translational research spectrum. The framework’s major proposition is that it situates D&I sciences as targeted “sub-sciences” of translational science to be used by CTSAs, and others, to identify and investigate coherent strategies for more routinely and proactively accelerating research translation. The framework highlights the importance of D&I thought leaders in extending D&I principles to all research stages.
Microscale testing has enjoyed significant developments, with the majority of testing focused on tensile/compression type tests and little focus on shear testing. With the recent advances in macroscale shear testing, we developed a novel shear structure for evaluating shear properties of bulk materials and films at the microscale. The shear response in single-crystal copper oriented along the  direction was found to have a yield strength of ∼180 MPa. Nanocrystalline copper specimens with different orientations showed sensitivity to the film texture with a shear yield strength nearly three times that of single-crystal copper. Shear specimens were fabricated with Cu film–Si substrate interface near the middle of the shear region and compressed to fracture. The shear response showed a mixed behavior of the stiff Si substrate and softer nanocrystalline film and failed in a brittle manner, indicating a response unique to the interface.
To examine whether social media and online behaviours are associated with unhealthy food and beverage consumption in children.
A cross-sectional online survey was used to assess Internet and social media use, including engagement with food and beverage brand content, and frequency of consumption of unhealthy foods and beverages. Linear regression models were used to examine associations between online behaviours, including engagement with food and beverage brand content, and consumption of unhealthy foods and beverages, adjusting for age, sex and socio-economic status.
New South Wales, Australia, in 2014.
Children aged 10–16 years (n 417).
Watching food brand video content on YouTube, purchasing food online and seeing favourite food brands advertised online were significantly associated with higher frequency of consumption of unhealthy foods and drinks after adjustment for age, sex and socio-economic status.
Children who have higher online engagement with food brands and content, particularly through online video, are more likely to consume unhealthy foods and drinks. Our findings highlight the need to include social media in regulations and policies designed to limit children’s exposure to unhealthy food marketing. Social media companies have a greater role to play in protecting children from advertising.
In this work, the deformation mechanisms underlying the room temperature deformation of the pseudomorphic body centered cubic (BCC) Mg phase in Mg/Nb nanolayered composites are studied. Nanolayered composites comprised of 50% volume fraction of Mg and Nb were synthesized using physical vapor deposition with the individual layer thicknesses h of 5, 6.7, and 50 nm. At the lower layer thicknesses of h = 5 and 6.7 nm, Mg has undergone a phase transition from HCP to BCC such that it formed a coherent interface with the adjoining Nb phase. Micropillar compression testing normal and parallel to the interface plane shows that the BCC Mg nanolayered composite is much stronger and can sustain higher strains to failure than the HCP Mg nanolayered composite. A crystal plasticity model incorporating confined layer slip is presented and applied to link the observed anisotropy and hardening in the deformation response to the underlying slip mechanisms.
A geological disposal facility (GDF) will include fissile materials that could, under certain conditions, lead to criticality. Demonstration of criticality safety therefore forms an important part of a GDF's safety case.
Containment provided by the waste package will contribute to criticality safety during package transport and the GDF operational phase. The GDF multiple-barrier system will ensure that criticality is prevented for some time after facility closure. However, on longer post-closure timescales, conditions in the GDF will evolve and it is necessary to demonstrate: an understanding of the conditions under which criticality could occur; the likelihood of such conditions occurring; and the consequences of criticality should it occur.
Work has addressed disposal of all of the UK's higher-activity wastes in three illustrative geologies. This paper, however, focuses on presenting results to support safe disposal of spent fuel, plutonium and highlyenriched uranium in higher-strength rock.
The results support a safety case assertion that post-closure criticality is of low likelihood and, if it was to occur, the consequences would be tolerable.